Know your heart conditions: diastolic dysfunction



Resource post for January

About 80 million adult Americans suffer from at least one type of cardiovascular disorder. This is equivalent to 1 in every 3 adults. Diastolic dysfunction is a commonly used term nowadays in connection with diagnosis of heart disease. This term, however, is fairly new, and the dysfunction has only been identified with improved diagnostic techniques.

What is diastolic dysfunction?

Before we can understand this disorder, we first have to understand how our heart works.

“Lub-dub” This is the sound that our heart makes with each and every heartbeat. And with every beat, the heart contracts and relaxes. The contraction phase when the ventricles contract to pump blood out of the heart is called the systole. The relaxation phase when the ventricles relax and get filled with blood pumped from above by the atria is the called diastole. The “lub-dub” sound is actually made by the heart’s valves as they close and open during the contraction – relaxation cycle.

Our heart has 4 valves, namely:

  • The tricuspid valve divides the right atrium from the right ventricle.
  • The mitral valve divides the left atrium from the left ventricle.
  • The pulmonary valve separates the right ventricle from the pulmonary artery, the big blood vessel that brings blood to the lungs.
  • The aortic valve is separates the left ventricle from the aorta, the big artery that carries blood from the heart to the body.

The soft “lub” is the sound that the mitral and tricuspid valves make when they close at the start of the systole or contraction phase. The louder “dub” is the sound that the aortic and pulmonary valves make when they close at the start of the diastole or relaxation phase.

Diastolic dysfunction occurs when the relaxation or diastolic phase of the heart does not proceed normally. This has something to do with “stiff” heart muscles leading to the failure of the ventricle to relax normally. This inability of the ventricle to completely relax results in:

  • the pressure in the ventricle to increase above normal.
  • difficulty for the blood to enter the ventricle in the next heartbeat.

According to the American Heart Association (AHA), when not managed properly, diastolic dysfunction leads to inefficient pumping of the heart and “can cause increased pressure and fluid in the blood vessels of the lungs (pulmonary congestion). It can also cause increased pressure and fluid in the blood vessels coming back to the heart (systemic congestion).” This can eventually lead to diastolic heart failure.

According to this article in the American Academy of Family Physicians (AAFP) site

diastolic heart failure is defined as a condition caused by increased resistance to the filling of one or both ventricles; this leads to symptoms of congestion from the inappropriate upward shift of the diastolic pressure-volume relation.”

A condition called systolic dysfunction also exists.

What causes diastolic dysfunction?

The disorder seems to be especially common in elderly women, even among those not previously diagnosed with heart disease. The following cardiovascular conditions can lead to the stiffening of the ventricles and thus diastolic dysfunction:

  • aortic stenosis
  • chronic hypertension
  • coronary artery disease
  • some forms of cardiomyopathy, e.g. hypertrophic and restrictive cardiomyopathy

How is diastolic dysfunction detected and diagnosed?

In its early stages, diastolic dysfunction does not manifest in obvious symptoms. Perhaps the earliest noticeable symptom would be dyspnea or shortness of breath. However, since this is a very common symptom for many kinds of diseases and disorders, diastolic dysfunction is often “missed” during routine medical check ups. Thus, “diastolic dysfunction may be present for several years before it is clinically evident.”

It its advanced stage, when diastolic dysfunction has progressed to the point of causing diastolic heart failure, the following symptoms and related conditions may be evident:

  • Abnormal heart rhythms such as atrial fibrillation
  • Periodic increase in blood pressure
  • Decreased tolerance to physical exercise
  • Severe breathlessness even without exertion
  • Edema or accumulation of fluids in the feet and ankles
  • Acute pulmonary congestion

A standard electrocardiogram or ECG unfortunately cannot easily distinguish between systolic and diastolic dysfunction. The most reliable but rather invasive diagnostic method is cardiac catheterization. As a less invasive alternative, a two-dimensional echocardiography with Doppler function can be used, although the physician must be well-trained in evaluating “the characteristics of diastolic transmitral and pulmonary venous flow pattern” in order to diagnose diastolic dysfunction.

How is diastolic dysfunction managed?

As in almost every disease, early diagnosis and treatment of diastolic dysfunction is important to prevent irreversible damage to the heart.

There is no easy way to treat diastolic dysfunction. However it can be effectively managed through treatment and management of the underlying conditions, namely:

High blood pressure. Management of hypertension is essential in the management of diastolic dysfunction. The AHA gives a comprehensive review of hypertension, including online tools to check for risk factors and blood pressure monitoring.

Coronary artery disease. CAD on its own requires aggressive management strategies to prevent heart attacks. This animation on the AHA site explains clearly how CAD develops.

Aortic valve stenosis. The aortic valve can also become stiff or is misformed at birth, resulting in aortic stenosis, a condition which puts a strain on the left ventricle. Usually, this condition is relieved by surgical interventions.

Arrhythmia. Abnormal heart rhythms such as atrial fibrillation need to be managed effectively to avoid further complications. The AHA site also gives a useful animation on atrial fibrillation. More information about arrhythmias can be found here.

Currently, there is a scarcity of conclusive data on therapies specifically for diastolic heart dysfunction and failure. However, the American College of Cardiology and the American Heart Association have jointly come up with guidelines which “recommend that physicians address blood pressure control, heart rate control, central blood volume reduction, and alleviation of myocardial ischemia when treating patients with diastolic heart failure. These guidelines target underlying causes and are likely to improve left ventricular function and optimize hemodynamics.” Medications used for the management of diastolic heart failure are summarized in this AAFP article (Table 4).

Can diastolic dysfunction be prevented?

Like many heart disorders, diastolic dysfunction and heart failure are preventable.

Primary prevention of diastolic heart failure includes smoking cessation and aggressive control of hypertension, hypercholesterolemia, and coronary artery disease. Lifestyle modifications such as weight loss, smoking cessation, dietary changes, limiting alcohol intake, and exercise are equally effective in preventing diastolic and systolic heart failure.”

Photo credits: stock.xchng

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Comments

  1. Crystal Murrieta says:

    So I am a 30 yr old female, my new physician has done some testing to see what caused an event back in 2007 where I unexpectedly collapsed and went into cardiac arrest. I was at that time, 27. Ive been struggling for answers with the hospitals and no one has taken the initiative to look into the why questions for me. They put a ICD defibrilator implant in, and let me walk out the door. As that being my safe guard for the rest of my life.
    An event was also recorded on the defibrilator after another unforseen fall while at work in 2010. I used to be in an active profession, and cannot even begin to ponder ever going back.
    I’m now working with the military hospitals to better tell what is going on, and what I can do to prevent the rest of my life from feeling like Im always on life’s edge. I cant workout the way I need to, I become light headed, dizzy, short of breath at times. When I know Im in real trouble, I usually feel like Ive knocked the wind out of myself. Things get blochy I start seeing spots, and my audio goes off (so I can hear ringing in my ears) before I pick myself up off the floor after my defibrilator goes off numerous times.
    The echo that was done just a couple months back said that I have Stage 1 diastolic dysfunction present, but I’m guessing the doctor doesnt naturally feel like telling me until a confirmation test is done.
    Can this be caused also by lack of dental care?

  2. anil kapur says:

    thank you very much for a well described artical on diastolic dysfunction.
    I am recently diagnosed for this problem ( Grade 1) ,
    non smoker non diabetic, Hpertensive ( 30 Years ) / untreated as had no sympotoms, history of TIA 8 years back. Gradualy developed short of breath over 5 years resulting in orthopnea.in last 6 months
    Episodes of frequent frank pulmonery congestion.
    Now being treated with antihypertensive telmesartan 40 mg + amlodipine 5 mg + diuretic frusemide 40 mg / hydroclorthiazide 12.5 mg.
    Recent angiogram ( Done to rule out CAD due to confusing symptomsof ) shows 2 arteries 15 % blocked + middle artery 40% blocked.
    Seek advise on CAN DIASTOLIC DYSFUNCTION BE IMPROVED BY YOGA besides regular medicinal therapy
    & how to prevent progression of diseas from grade 1 to garde 2 / 3/ 4

  3. Emma, thanks for info. I am 52 and was diagonised diastolic dysfunction last month and I am very active person, body weight less than average. I was surprised to know this since this was least expected. My E/A ratio is 0.85 and shall be grateful if someone can advise on natural remedy. With 0.85 E/A ration, is it serious ? I had no symptoms and my treadmill test results are better than normal.

  4. Hi, I was recenly diagnosed with diastolic dysfuntion. The reason I kept going from one Dr. to another was that I couldnt exercise like I used to or keep up with friends my age (I am 68). I has always been very active, biking, skiing, swimming, hiking, yoga, y ou name it, I did it and loved it. Then I seemed to be going downhill, and became short of breath whenever I did anything. After a while even coming up stairs bothered me. Some Dr.’s treated me like I had a mental problem. Believe me I would rather not go to Drs., but be outside, even gardening was getting so hard. Finally I found a very good Cardio Dr. at University Hospital in Denver and he believed me and did all the necessary tests. I have also developed a lot of edema and pulmonary hypertension. I just hope medication will help me, I am planning to go skiing and biking again and hope I can.
    Thanks for your website.
    Emma

  5. Heart disease is among the top ten of cause of mortality among many countries around the world. Different types have different causes; ranging from bacterial causes like rheumatic heart disease to atherosclerosis causing CAD. This post will help a lot of people to learn more about cardiovascular related diseases.
    I will be so delighted if you will exchange link with me at
    www.promdinurses.com

  6. THANK-YOU for this article Raquel … and all of the links! Muchly appreciated 🙂

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.
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